Provider Demographics
NPI:1518974229
Name:UDANI, CHANDRAKANT I (MD)
Entity Type:Individual
Prefix:MR
First Name:CHANDRAKANT
Middle Name:I
Last Name:UDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 ASBURY AVE.
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226
Mailing Address - Country:US
Mailing Address - Phone:609-399-1519
Mailing Address - Fax:609-398-4712
Practice Address - Street 1:5548 ASBURY AVE.
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-1236
Practice Address - Country:US
Practice Address - Phone:609-399-1519
Practice Address - Fax:609-398-4712
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03731800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1490303Medicaid
NJC54490Medicare UPIN
NJ1490303Medicaid
C54490Medicare UPIN